clinical trials of new drugs,organ transplants involving ethical issues were explored

Heart Failure ; therapy ; Humans ; Practice Guidelines as Topic

Objective To investigate the impact of cavoplasty on the piggy back liver transplantation and on the prevention of hepatic outflow block. Methods Three patients received modified piggy back liver transplantation with venacavoplasty under single veno venous bypass. Results All the recipients had stability of dynamic circulation, short anhepatic phase and decreased hemorrhage during operation. Postoperatively all the patients recovered quickly with good liver function without any complications. Conclusions Venacavoplasty may overcome outflow block in piggy back liver transplantation and the technique can shorten anhepatic phase and decrease complications.

AIM: To investigate whether hepatocyte apoptosis is contributed to liver ischemia-reperfusion (I/R) injury and the relationship between liver caspase-3 activity and hepatocyte apoptosis in cirrhotic rats. METHODS: Liver ischemia-reperfusion is induced by Pringle maneuver. The cirrhotic rats were randomized into two groups: Group A: simple hepatic blood inflow occlusion (HBIO); Group B: HBIO + inhibitor, before HBIO, ZVAD-fmk 15 mg/kg was injected via dorsal penis vein; Group C: healthy rat, simple HBIO. The ischemia time was 30 min in these groups. Serum aspartate aminotransferase(AST), liver caspase-3 activity, and apoptotic hepatocytes were examined in the three groups. RESULTS: After 6 h of reperfusion, the liver caspase-3 activity was markedly elevated and reached its peak, which was statistically higher than that of before I/R ［(18.1±1.8 ) μmol*h-1*g-1 (tissue) vs (6.6±2.0) μmol*h-1*g-1 (tissue), P＜0.01］. The same change occurred in hepatocyte apoptosis between 6 h of reperfusion and before I/R (20.9%±4.9% vs 0.5%±0.3%, P＜0.01). As the reperfusion prolonged, the caspase-3 activity and apoptotic hepatocyte decreased gradually. The 7th-day survival rate was 62.5% in group A. The serum AST, liver caspase-3 activity and apoptotic hepatocytes were significantly higher in group A than those in group B and C, representing the most severe liver injury among the three groups. CONCLUSION: Hepatocyte apoptosis is the major form of cell death in liver ischemia-reperfusion injury in cirrhotic rats. Hepatoctye apoptosis induced by I/R is caspase-3 dependent, and inhibiting caspase-3 can alleviate liver injury. The caspase-3 dependent hepatocyte apoptosis is highly contributed to the pathological phenomenon that the ischemic sensitivity of cirrhotic liver is higher than normal liver.

5 cases of orthotopic live transplantation (OLTX) were performed in unresectable hepatic cellular carcinoma(3),Wilson's disease(1)and hepatitis B(1).The donor livers were harvested by the technique of rapid multiple organ harvesting,flushed and preserved with UW solution.The veno-venous bypass was introduced during the anhepatic phase in the operation.The double or triple-drug immunosuppressive regimen was used and three episodes of acute rejection were controlled in two patients.One patient died of CMV infection and another,of upper gastrointestinal hemorrhage on the 92nd and 58th postoperative day respectively.The other three are still alive for 35,150 and 210 days.

Objective To evaluate the significance of p53 protein expression of hepatocellular carcinoma (HCCs) cells after transcatheter arterial chemoembolization(TACE). Methods A total of 136 patients with HCC underwent liver resection. One to five courses of TACE prior to liver resection were performed in 79 patients (TACE group), in which one to four courses of chemotherapy alone were performed in 11 patients (Group A), one to five courses of chemotherapy combined with iodized oil were performed in 33 patients (Group B), one to three courses of chemotherapy combined with iodized oil and gelatin sponge were performed in 23 patients (Group C), and one to three courses of chemotherapy combined with iodized oil, ethanol and gelatin sponge were performed in 12 patients (Group D). The other 57 patients only received liver resection (non-TACE group). The extent of apoptosis was analyzed by transferase-mediated dUTP nick end labeling (TUNEL) staining. The expressions of Bcl-2, Bax, Ki-67 and PCNA proteins were detected by immunohistochemical method. Results p53 protein expressions of trabecular and clear cell HCCs were significantly lower than those of pseudoglandular, solid, poorly differentiated or undifferentiated and sclerosis HCCs (P

Objective To investigate the selection of the types of anastomosis of bilioenterostomy and evaluate the therapeutic effects.Methods From 1990 to 2000,536 patients with obstructive jaundice underwent bilioenterostomy in our hospital.The patients included 279 cases(52%) of hilar strictures with hepatolithiasis,108 cases(20%) of end stage periampullary tumors,96 cases(17%) of proximal cholangiocarcinoma and 53 cases(12%) of congenital choledochus cyst.The types of anastomosis included extra or hilar hepatic bilioenterostomy in 302 cases(56%),intra hepatic duct anastomosis with different type of hepatectomy in 222 cases(42%),of which 44 cases(8%) were anastomosed by roud ligament approch,27 cases(5%) through gallbladder fossa.Results The short term and 1～9 years long term follow up indicated that the jaundice of different patients can be completed relieved by suitable type of bilioenterostomy.Conclusions The good therapeutic effects of bilioenterostomy come from the correct selection of the anastomosis methods.

AIM: To investigate whether hepatocyte apoptosis is contributed to liver ischemia-reperfusion (I/R) injury and the relationship between liver caspase-3 activity and hepatocyte apoptosis in cirrhotic rats. METHODS: Liver ischemia-reperfusion is induced by Pringle maneuver. The cirrhotic rats were randomized into two groups: Group A: simple hepatic blood inflow occlusion (HBIO); Group B: HBIO + inhibitor, before HBIO, ZVAD-fmk 15 mg/kg was injected via dorsal penis vein; Group C: healthy rat, simple HBIO. The ischemia time was 30 min in these groups. Serum aspartate aminotransferase(AST), liver caspase-3 activity, and apoptotic hepatocytes were examined in the three groups. RESULTS: After 6 h of reperfusion, the liver caspase-3 activity was markedly elevated and reached its peak, which was statistically higher than that of before I/R [(18.1?1.8 ) ?mol?h -1 ?g -1 (tissue) vs (6.6?2.0) ?mol?h -1 ?g -1 (tissue), P

Objective To summerize the experience in diagnosis and surgical treatment for hilar cholangiocarcinoma in recent years.Methods 86 consecutive cases of hilar cholangiocarcinoma were surgically treated in this hospital from Jan. 1992 to Oct. 1998. Results The tumor resection rate was 37%(32/86) in this series. The postoperative morbidity and mortality rate were 47% and 7% respectively. The median survival time in palliative resection group was 16 months and the 1-year, 3- year, 5-year survival rate was 63%,21%,15% respectively. For curative resection,the median survival time was 19 months and the 1-year, 3- year, 5-year survival rate was 80%,35%,25% respectively( P =0 038). For drainage group, the median survival time was 5 months and the 1-year, 3- year, 5-year survival rate was 28%,8 4%,5% respectively.Conclusion Early diagnosis, improvement of patients′ general preoperative condition and the surgical expertise may help in increasing the curative resection rate and reducing postoperative morbidity and mortality rate, which are keys to prolong patients′ survival.

Objective To evaluate a reliable and noninvasive method for the diagnosis of acute rejection after liver transplantation.Methods The allogeneic, syngeneic and immunosuppresive models of orthotopic rat liver transplantation were established, and acute rejection was graded according to histopathological change. Bile was sent for cytology by microscopy,and the sequential detection of bile IL 2,IFN ?,IL 4 and IL 6 gene expression was performed at day 1 through day 7. Results The number of cells in bile was persistently high in allogeneic group,and blast and lymphocytes appeared in bile. IL 2 and IFN ? were detected only in allogeneic group,with a specificity of 70% and 67%(7/10 and 8/12),and a sensitivity of 39% and 44%(7/18 and 8/18)respectively.Conclusion Bile cytology and detection of IL 2 and IFN ?mRNA transcript are useful adjuvant diagnosic methods for acute rejection after liver transplantation.